BCBS Claim Form
Reimbursement for covered out-of-pocket medical expenses (excluding required copayments/coinsurance/deductible amounts) that you may have incurred inside the United States while actively covered under the Student Health Insurance Plan.
Claim Form Online Submission (International Claims Excluded)
The BCBSMA online claim submission process is temporarily unavailable as they work to improve the member experience. Please use our paper forms to submit claims for reimbursement. We apologize for any inconvenience.
BCBS Dental Blue Claim Form
Reimbursement for covered out-of-pocket expenses (excluding required copayments/coinsurance) that you may have incurred while actively covered under the Dental Blue Plan.
BCBS International Claim Form
Reimbursement for covered out-of-pocket medical expenses (excluding required copayments, coinsurance, and deductible) that you may have incurred outside of the United States while actively covered under the Student Health Insurance Plan. Students should use this form for both medical and prescription drug claims.
BCBS Weight Loss Reimbursement Form
Reimbursement for qualifying weight loss programs.
To receive your reimbursement for taking a childbirth course or refresher course, submit the claim form along with proof of payment and a copy of your completion certificate.
CVS Caremark Prescription Drug Claim Form
Effective January 1, 2023, CVS Caremark will support Blue Cross Blue Shield of Massachusetts in managing pharmacy services.
Use this form if you need to file for reimbursement for expenses you paid out of pocket on prescriptions. You will not be reimbursed for applicable co-payments/coinsurance.
Prescription Drug Claim Form
Use this form for prescriptions purchase prior to January 1, 2023.
The Blue Cross Blue Shield of Massachusetts prescription drug benefit is administered by Express Scripts® (ESI). Use the ESI claim form to file a reimbursement for prescription expenses for which you paid out of pocket while actively covered under the Student Health Insurance Plan. You will not be reimbursed for applicable co-payments/coinsurance.
Travel Benefit Reimbursement Form
Under the medical benefits travel rider, Blue Cross Blue Shield of Massachusetts will reimburse members for certain expenses related to travel to obtain covered services other than routine or preventative care when access to those services is not available within 100 miles of the member’s home and the member must travel to obtain the services.
Open enrollment ends September 30. Students enrolling in an individual plan must use the student insurance portal. Students enrolling with their dependents should use the dental application that is available on the dental section of our website.
Post-Doc Affiliate Enrollment
Post-doctoral affiliates (also known as post-doctoral fellows) are eligible to enroll as long as they have a current appointment, were recently awarded a Ph.D. or equivalent doctorate in an appropriate field, and are not eligible for employer-sponsored health insurance.
Student Dependent Health Insurance Cancellation Policy
A student may request a cancellation of the Harvard University Student Health Program for their dependent(s) through Member Services. This request will cancel both parts of the insurance, the Student Health Fee and the Student Health Insurance Plan; the option to cancel only one part of the program is not available. The date we receive the cancellation form to cancel their dependent(s) coverage will determine their cancellation options.
Affiliate Health Insurance Cancellation Policy
Affiliates may be eligible to cancel health insurance if they meet the criteria.
Active Duty Military Attestation
Active military duty personnel may be eligible to waive the Student Health Fee. Complete the attestation form and return it to Member Services.
Leave of Absence/Withdrawal
Students may apply for six months of additional coverage due to Leave of Absence or Withdrawal from the University. The additional coverage starts on the last day of student coverage, and important time restrictions apply.
Students who previously waived the Student Health Insurance Plan may be eligible to re-enroll based on certain criteria.
Student coverage ends depending upon the day the student completes degree requirements.
This form is for members to declare their eligibility for Medicare.
Dental Blue Cancellation Policy
Students may elect to cancel the option Dental Blue Plan if they meet the criteria.
Change in Plan Type
Students may elect to change the Dental Blue Plan in which they enrolled if they meet the criteria.
Members can request a cost estimate if they meet eligibility guidelines and are currently enrolled in the health plan. An estimate does not guarantee coverage, and each admission, procedure, or service must be a medically necessary covered benefit and meet medical guidelines. All prior authorization and referrals must be obtained, if necessary.
There are two options for receiving an estimate of your financial responsibility for an upcoming service or procedure.
Estimates from Your Insurance Plan
Visit the Blue Cross Blue Shield of Massachusetts website and log into MYBLUE or call 1 (800) 257-8141 for assistance. To help get you started, use the Blue Cross Blue Shield checklist form, which provides guidelines on what information you need in order to receive an estimate. Once you are logged into MYBLUE, you can also:
View claims online
Monitor your deductible and out-of-pocket maximum
Request a written estimate
Estimates from Your Provider
All providers are now required to provide cost estimates for service they provide. Talk to your provider about obtaining an estimate prior to receiving care.
The Affordable Care Act requires the Harvard University Student Health Program (HUSHP) to provide membership information for the calendar year to the Internal Revenue Service.
Members enrolled in the Student Health Insurance Plan (Blue Cross Blue Shield of Massachusetts) should expect to receive a 1099-HC form and, depending on where your address was recorded, a 1095-B form.
The 1099-HC form is applicable only when filing taxes in Massachusetts. Blue Cross Blue Shield of Massachusetts mails the 1099-HC form to all subscribers by January 31 of the following year. If you did not receive a 1099-HC form and would like to request a copy, please call Blue Cross Blue Shield of Massachusetts at 800-257-8141 or request a form online through MyBlue.
Students whose address was recorded as being in RI, NJ, DC, or CA for 2021 will receive a printed form from our vendor, Thomson Reuters. This form is for your tax records and confirms that you were enrolled in a plan that met minimum essential coverage requirements.
You do not need this form to file your federal taxes.
If your address is recorded as being in RI, NJ, DC, or CA and you did not receive a 1095-B form, contact HUSHP Member Services. Learn more about the Internal Revenue Service requirements or view a sample 1095-B Form.
What information do I need to file my taxes?
- Your Blue Cross Blue Shield policy ID number
- The Federal ID (FID): 04-1045815
- The months in which you were insured
This form may not be applicable to all students, particularly those who do not file taxes in the United States with the Internal Revenue Service. Additionally, please be aware that if your 1095-B includes a SSN, and you do not have a federally issued SSN, this is because Blue Cross Blue Shield of Massachusetts had to create a pseudo (fake) SSN for you to be enrolled in their system. This does not mean that you have been issued a SSN by the government. Please consult a tax advisor if you have questions.
Students without a Social Security Number (SSN)
Please be aware that Blue Cross Blue Shield of Massachusetts created a numeric code to enroll you in health insurance. That numeric code is displayed on your 1095-B form and IS NOT a SSN issued by the United States government. Please consult a tax adviser if you have questions.